GLUTEN3S Research Group, Department of Nutrition and Food Science, University of the Basque Country, 01006 Vitoria-Gasteiz, Spain.
Laboratory of Gastroenterology and Trace Elements, Department of Laboratory Medicine, Hospital Universitario La Paz, 28046 Madrid, Spain.
Nutrients. 2023 Sep 16;15(18):4013. doi: 10.3390/nu15184013.
The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.
无麸质饮食（GFD）在儿童和成人中仍然是管理乳糜泻（CeD）的复杂模式，有很多原因需要严格遵守 GFD 以改善结果。然而，这对患者来说是一项具有挑战性的任务，因为他们需要获得优质的医疗保健资源，以促进最佳 GFD 依从性。了解 GFD 的优缺点，解决共存的营养缺乏问题，并处理复杂情况，如血清阴性 CeD 或无反应性 CeD，都需要多学科团队的参与。CeD 患者的短期和长期随访最好由联合消化科和营养科进行，这些科室具有明确的质量标准，并涉及医生、护士、营养师和心理学家等多学科人员。有经验的营养师提供的营养建议和咨询可以降低 CeD 患者长期随访相关的成本。同样，在某些情况下，心理干预可能是必要的，因为终生坚持 GFD 可能会给患者带来重大的心理负担。本文旨在提供改善 CeD 患者随访和监测的临床实践指南，并提供关于不当 GFD 的营养风险信息。参与撰写的人员包括具有全球视野的临床医生、生化学家、食品技术人员、营养师和心理学家。
